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Registration
 
Register to vote for the grant giveaway by filling out the form below.
 
General Information
 
* Public Name: 
 
  Must be 4-10 characters
 
* Email: 
 
  Only one registration is allowed per email address.
 
* Confirm Email: 
 
* First Name: 
 
* Last Name: 
 
* Gender: 
 Male      Female
 
* Phone: 
 
  Will only be used to contact winners.
 
* Postal Code: 
 
Password Information
 
Passwords must be 8 to 20 characters.
 
* Password: 
 
* Confirm Password: 
 
Double check to make sure your information is correct and then hit submit below. Thank you for your participation.
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NBC4 Make A Difference Grant

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